{"main_topic":"health","sub_topic":"cms","topic":"medicare_er_visits","key":"health/cms/medicare_er_visits","version":"1.0.0","year_min":2014,"year_max":2024,"year_gaps":[],"update_frequency":"annual","detail_levels":["counties","states"],"default_detail":"counties","path_template":"health/medicare_er_visits/year={year}/{detail}.parquet","grain":["year","county_fips","tract_geoid","age_bracket"],"title":"Medicare Emergency Room Visits per 1,000 Beneficiaries (CMS)","summary":"Hospital emergency room visits per 1,000 Original Medicare beneficiaries in Georgia and its counties.","description":"Hospital emergency room (ER) visits by Original Medicare (fee-for-service) beneficiaries in Georgia and each of its 159 counties, per 1,000 beneficiaries a year, with the visit and beneficiary counts. A visit counts whether the person went home or was admitted. Statewide, 709 visits per 1,000 in 2014 and 564 in 2024; counties ranged from 372 to 873 in 2024. 2014-2024, from CMS's Medicare Geographic Variation public use file. Medicare Advantage members are not counted (60% of Georgia's beneficiaries with Part A and B in 2024).","explorer":true,"search_aliases":{"en":["seniors in the ER","older adults ER visits","medicare emergency room","medicare ER use","ER utilization","hospital ER medicare","emergency care seniors"],"es":["urgencias de medicare","adultos mayores en emergencias","uso de urgencias","visitas a emergencias medicare","sala de emergencias medicare","urgencias en hospitales","emergencias para mayores"]},"source":"Centers for Medicare & Medicaid Services (CMS), Medicare Geographic Variation - by National, State & County, data.cms.gov dataset 6219697b-8f6c-4164-bed4-cd9317c58ebc, 2014-2024 release (2014-2024 Original Medicare Geographic Variation Public Use File.csv)","source_url":"https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-geographic-comparisons/medicare-geographic-variation-by-national-state-county","endpoint":"/api/v1/health/medicare_er_visits","columns":[{"name":"year","type":"integer","role":"year","nullable":false,"label":"Year","short_description":"","description":"Calendar year of service (claims by date of service, January to December), 2014-2024 (CMS's 2014-2024 release).","valid_values":null,"example":2024,"unit":null,"value_min":null,"value_max":null,"null_meaning":null,"key_metric_grain_contributor":false,"metric_component":null},{"name":"county_fips","type":"string","role":"fk_county","nullable":true,"label":"County FIPS","short_description":"","description":"5-digit county FIPS code of the beneficiaries' residence (CMS BENE_GEO_CD); NULL on the Georgia state row. CMS's GA-UNKNOWN (13000) is left out.","valid_values":null,"example":"13121","unit":null,"value_min":null,"value_max":null,"null_meaning":null,"key_metric_grain_contributor":false,"metric_component":null},{"name":"tract_geoid","type":"string","role":"fk_tract","nullable":true,"label":"Tract GEOID","short_description":"","description":"Always NULL: CMS publishes state and county figures only. Kept for the health domain's standard key shape.","valid_values":null,"example":null,"unit":null,"value_min":null,"value_max":null,"null_meaning":null,"key_metric_grain_contributor":false,"metric_component":null},{"name":"age_bracket","type":"string","role":"categorical","nullable":false,"label":"Age Bracket","short_description":"'all' = every beneficiary; 'under_65' / '65_plus' (Georgia only).","description":"Beneficiary age group (CMS BENE_AGE_LVL): 'all' (every age), 'under_65' (entitled by disability or end-stage renal disease) and '65_plus'. CMS publishes the two brackets for Georgia only; county rows are 'all'. The brackets partition 'all': their visits and beneficiaries add up to it exactly and its rate lies between theirs. Pin 'all' to compare places.","valid_values":["all","under_65","65_plus"],"example":"all","unit":null,"value_min":null,"value_max":null,"null_meaning":null,"key_metric_grain_contributor":true,"metric_component":null},{"name":"er_visits_per_1000_beneficiaries","type":"number","role":"metric","nullable":true,"label":"ER Visits per 1,000 Original Medicare Beneficiaries","short_description":"Hospital emergency room visits per 1,000 Original Medicare beneficiaries in the year.","description":"Hospital emergency room (ER) visits by the place's Original Medicare (fee-for-service) beneficiaries in the year, per 1,000 of them: num_er_visits x 1,000 / num_om_beneficiaries (CMS ER_VISITS_PER_1000_BENES, as published, 4 decimals; checked against the two counts on every row). Counts visits, not people: a visit counts whether the person went home or was admitted, and each repeat visit counts. Not per 1,000 Medicare enrollees: Medicare Advantage members are not counted. For several counties, pool as SUM(num_er_visits) * 1000.0 / SUM(num_om_beneficiaries), never an average of the county rates.","valid_values":null,"example":563.9321,"unit":"rate_per_population","value_min":null,"value_max":null,"null_meaning":"Suppressed by CMS ('*': a rate built on fewer than 11 beneficiaries or fewer than 11 beneficiaries with an ER visit): none on a served row in this release. Or not produced by CMS ('NA'): none on a served row in this release. Never filled in from other figures.","key_metric_grain_contributor":false,"metric_component":null},{"name":"num_er_visits","type":"integer","role":"metric","nullable":true,"label":"ER Visits","short_description":"","description":"Hospital emergency room visits by the place's Original Medicare beneficiaries in the year, inpatient or outpatient (CMS BENES_ER_VISITS_CNT: despite its name, a count of visits, not of beneficiaries). The numerator of er_visits_per_1000_beneficiaries. Adds across counties; never add it to medicare_service_utilization's outpatient visits or evaluation and management events, which count the same visits again.","valid_values":null,"example":403825,"unit":"count","value_min":null,"value_max":null,"null_meaning":"Suppressed by CMS ('*': a count built on fewer than 11 beneficiaries or fewer than 11 beneficiaries with an ER visit): none on a served row in this release. Or not produced by CMS ('NA'): none on a served row in this release. Never filled in from other figures.","key_metric_grain_contributor":false,"metric_component":"numerator"},{"name":"num_om_beneficiaries","type":"integer","role":"metric","nullable":true,"label":"Original Medicare Beneficiaries","short_description":"","description":"Original Medicare (fee-for-service) beneficiaries living in the place: Part A, Part B and Original Medicare for every month they were entitled, new enrollees and people who died during the year included (CMS BENES_OM_CNT). Not every Medicare beneficiary: Medicare Advantage enrollees and people with Part A or B alone are left out. The denominator of er_visits_per_1000_beneficiaries.","valid_values":null,"example":716088,"unit":"count","value_min":null,"value_max":null,"null_meaning":"Suppressed by CMS (fewer than 11 beneficiaries). Not seen on any state or county row in the current release.","key_metric_grain_contributor":false,"metric_component":"denominator"}],"key_metric":"er_visits_per_1000_beneficiaries","numeric_filter_columns":["er_visits_per_1000_beneficiaries","num_er_visits","num_om_beneficiaries"],"usage":"Star-schema fact table at state and county grain, one row per place, year and age bracket: state rows have county_fips NULL, county rows join the counties dimension on county_fips; tract_geoid is always NULL. Pin age_bracket = 'all' to compare places (county rows are 'all' only; 'under_65' and '65_plus' are Georgia's own rows, and they add up to 'all'). er_visits_per_1000_beneficiaries is CMS's rate, num_er_visits x 1,000 / num_om_beneficiaries. For several counties, pool as SUM(num_er_visits) * 1000.0 / SUM(num_om_beneficiaries) within one year, over counties with both published, never a plain average of county rates; for Georgia use the state row. Counts add across counties. Never add ER visits to medicare_service_utilization's hospital outpatient visits or evaluation and management events: one ER visit counts in each. Read directly with DuckDB over Parquet.","limitations":"Original Medicare (fee-for-service) only: beneficiaries in Original Medicare Parts A and B, counted for each month entitled, not all enrollees. In 2024 those beneficiaries were 35% of Georgia's Medicare beneficiaries and 20-49% of each county's (Medicare Advantage up to 76%, Clayton County), so county figures can describe a fee-for-service minority. Rates count ER visits, not people, per 1,000 of those beneficiaries. Georgia's row is CMS's own figure, not a sum of its counties. Who is covered: CMS counts beneficiaries with Part A, Part B and Original Medicare for every month they were entitled (num_om_beneficiaries), new enrollees and people who died during the year included; anyone in Medicare Advantage at any point in the year, or with Part A or Part B alone, is left out. An ER visit is a hospital emergency room visit whether the person went home or was admitted (CMS counts inpatient and outpatient ER visits); each repeat visit by the same person counts. The same visit can also appear in medicare_service_utilization, as a hospital outpatient visit (if the person went home) and as the ER doctor's evaluation and management event: never add ER visits to those. Georgia's rate fell 20% from 2019 to 2020, the first year of the COVID-19 pandemic (687 to 551 per 1,000), and was still below its 2019 level in 2024 (564). Trends also reflect who stays in Original Medicare: beneficiaries under 65 (entitled by disability or end-stage renal disease), whose rate is higher (862 vs 533 per 1,000 at 65 and over in 2024; higher in every year), fell from 20% to 9% of Georgia's Original Medicare beneficiaries between 2014 and 2024, which by itself pulls the all-ages rate down. CMS suppresses figures built on fewer than 11 beneficiaries or service users ('*'); they are NULL here and never filled in from other figures. No served figure is suppressed in this release. CMS's GA-UNKNOWN row (13000), beneficiaries placed in no county, is fully suppressed and left out. Georgia's row is CMS's own figure, not a sum of the county rows: it also counts the handful of beneficiaries CMS places in no county (GA-UNKNOWN), so the 159 counties need not add up to it exactly. age_bracket 'under_65' (beneficiaries entitled by disability or end-stage renal disease) and '65_plus' exist for Georgia only; county rows are 'all'. The two brackets' visits and beneficiaries add up to 'all' exactly. CMS also publishes the share of beneficiaries with at least one ER visit; it counts people, not visits, and is not in this table. From CMS's 2014-2024 release (file updated 2026-04-29); each release restates earlier years, so the figures here are replaced when the data is refreshed. tract_geoid is always NULL.","null_semantics":{"suppressed_to_null":true,"zero_is_real":true},"available_years":[2014,2015,2016,2017,2018,2019,2020,2021,2022,2023,2024],"schema_hash":"070f9032c0a1465350f3a8b30cc6e3a597e7d9d5dee0a5f08c0895b93c2b7a14","tags":["health","centers for medicare & medicaid services","medicare_er_visits"],"granularity_description":"One row per year, county_fips, tract_geoid, age_bracket (geography columns are NULL at higher aggregation levels).","example_queries":[{"description":"Latest year (2024), counties detail","query":"SELECT * FROM medicare_er_visits WHERE year = 2024 LIMIT 100"},{"description":"Filter by age_bracket = all","query":"SELECT * FROM medicare_er_visits WHERE age_bracket = 'all' AND year = 2024 LIMIT 100"}],"foreign_keys":[{"column":"county_fips","target_object":"counties","target_columns":["county_fips"],"attribute_columns_added":["county_name"],"scope":"global"},{"column":"tract_geoid","target_object":"tracts","target_columns":["tract_geoid"],"attribute_columns_added":["tract_name"],"scope":"global"}],"filters":[{"param":"year","kind":"year_exact","type":"integer","multi_value":false,"enum_enforced":false,"values":null},{"param":"year_min","kind":"year_range","type":"integer","multi_value":false,"enum_enforced":false,"values":null},{"param":"year_max","kind":"year_range","type":"integer","multi_value":false,"enum_enforced":false,"values":null},{"param":"detail","kind":"detail","type":"string","multi_value":false,"enum_enforced":true,"values":["counties","states"],"default":"counties"},{"param":"county_fips","kind":"foreign_key","column":"county_fips","type":"string","multi_value":true,"enum_enforced":false,"values":null},{"param":"tract_geoid","kind":"foreign_key","column":"tract_geoid","type":"string","multi_value":true,"enum_enforced":false,"values":null},{"param":"age_bracket","kind":"categorical","column":"age_bracket","type":"string","multi_value":true,"enum_enforced":true,"values":["all","under_65","65_plus"],"has_total":true,"total_value":"all","requires_single_value":false,"nullable":false,"null_filter_token":null}],"filter_hints":[],"non_additive":[],"partitions":[],"value_implications":[],"year_meaning":null,"pooled_rates":[],"series_breaks":[],"year_window":null,"pooled_min_count":null,"values_endpoint":"/api/v1/health/medicare_er_visits/values"}